Download Psychotherapy: No Side Effects

Psychotherapy: No Side Effects
I don't watch much television, but now and then I notice one of those
commercials for psychiatric medication promising relief from anxiety, depression,
and other distressing conditions. The ads always end with a long list of possible
side effects, including some rather frightening ones. These are glossed over in a
soft-spoken, rapid-fire delivery that contrasts sharply with the hopeful portrayals
and enthusiastic endorsements presented a few seconds earlier.
Despite the guise of offering help, it is easy to appreciate the profit motive of the
drug companies sponsoring these ads. They are attempting to sell happiness,
more or less in the same way that manufacturers of luxury cars or stain-resistant
carpeting do: we have a product that will change your life—for the better!
And, despite the threat of side effects, these ads are quite successful, with more
than $40 billion in psychiatric drug sales in 2008. This, too, is understandable.
Both legal and illegal drugs appeal to those who would like a quick, convenient
solution to their unhappiness and who presume that addiction and other
complications happen only to other people. A prescription can often be obtained
from a familiar and trusted primary care physician, so one doesn't need to see a
psychiatrist and think of oneself as a "mental case." Nor need one consult a
psychologist to investigate the causes of distress or explore better ways to cope.
Although medication has an important role to play in mental health, that role
should not be determined by the sales goals of marketing departments
manipulating the demand for their product. A wise use of medication
presupposes a careful history and assessment, a thoughtful weighing of risks
and benefits, and regular monitoring of results. Wiser still would be to
appreciate the role psychotherapy can play, both instead of and as a
complement to medication.
The huge success of the drug company advertising campaigns has left most
people with the impression that medication is the up-to-date remedy for
emotional distress. They have been sold on the idea that their troubles stem
from a "chemical imbalance," the solution to which, of course, involves
rebalancing their chemicals, just like diabetics taking insulin. As plausible as this
clichéd description sounds, it has no scientific support. Despite intense research
efforts, no biological cause for even the most serious mental illnesses has been
demonstrated.
Scientific journals and professional books increasingly document the superiority
of psychotherapy over medication for many people, but their audience is small.
Occasionally, the general media report on this issue, as The New York Times did
last year when Elissa Ely described how experienced psychiatrists having their
own life crises apparently still prefer the wisdom and insight of experts in
psychotherapy over the marvels in the medicine cabinet. Surprised that doctors
hesitate to rely on pills? I'm not. The talking cure remains the most complete
and desirable route to recovery for the vast majority of emotional problems.
For every person who read that article, or others like it, there are probably a
hundred exposed to pharmaceutical marketing. Sadly, there is no competition to
the drug ads on television permitting the public to hear an alternative point of
view. There are no equivalents to Big Pharma buying time to talk about how
weak the evidence is for the effectiveness of psychiatric medication (especially in
the long term), how devastating the side effects can be, and how much solid
research supports the effectiveness of psychotherapy. And, of course, there is
no quiet voice at the end to point out that the talking cure has no side effects.